The Optimized Doctor

What Alaska can teach us about burnout


Some people have nightmares of giant rats attacking from their basements, others encounter monsters from a Stephen King novel. My nightmares are of clinic where time is the beast pursuing me. In my nightmares, I’m running late and can’t get to my next patient, or I’m trapped somehow and unable to get to clinic at all.

an infinity clock showing an endless spiral of time, with no clock hands liseykina/thinkstockphotos

infinity clock

Time demands that I provide patients access quickly, start clinic on time, double my speed to make up for add-ins, or worse, late patients. Time is a constant, relentless monster, one that has apparently infiltrated my subconscious. Yet, time is relative.

Over Memorial Day weekend, my wife and I flew from San Diego to Alaska. Somewhere between those places time transforms – early summer in San Diego becomes early spring in Alaska.

When we landed, daffodils were in bloom, buds on the alders were just arriving, and the sun struggled to warm the air to 50 degrees. The daytime defied gravity: it was daylight by 4 a.m. and still so after 11 p.m. We were the first visitors this season in our little cabin near Seward.

“Your hot water might take a bit to get hot,” our host, Jim, informed us. He wore a thick flannel shirt and Carhartt workman trousers. He leaned against the cabin’s door frame with one hand at the top and the other hanging from the weight of a DeWalt drill at his side. “I made these cabins myself,” he informed. I was anxious to move on, to unpack and start exploring, but every time I tried to break away from his conversation, he extended it. He shared how a cow and calf (that’s moose talk) had come through earlier that morning. Then he told us about working in the timber industry, starting by “pulling green chain” and working his way up to being the keeper of the saws. While he talked, I watched a raven drop down from the tall Sitka spruce to a branch just across from where we parked our car. Just behind Jim, the raven was not only watching, but also listening in on our conversation. Jim pointed, “That bit of snow over there was all that was left from the 12-foot-high snow earlier this year. It was an easy winter.” He then advised we should start our trip with a visit to Exit Glacier. It was reachable by road and an easy hike.

Exit Glacier and Harding Ice field Trail, Seward , Kenai Peninsula, Alaska Leamus/iStock/Getty Images

Staying upright on the steep trail to the glacier’s Harding Icefield concentrates the mind. Looking down and across the glacial outwash, I imagined how the ice once thousands of feet above my head carved a valley from rock. Ice compacted so completely and so deep that only blue light escapes. Indeed, a glacier is just a pile of unmelted snow, thousands of years in the making. The Kenai fjords, deep enough that humpback whales swim there, were carved from granite – at glacial speed. Some of the rocks there contain fossils all the way from the tropics. They were transported by the Pacific tectonic plate that has rotated counterclockwise from the equator to Alaska over millions of years – at tectonic speed. Life here has a way of sharpening your focus, allowing you to see perspective as exists in nature. Alaska is so old that an ob.gyn. could have seen his or her first patient here – a mother with a stillborn child – at the Upward Sun River, 11,500 years ago, where in 2013, the fossil remains of a late-term fetus dating back to that time was discovered. It is indeed relative.

After a long hike, a crispy, hot halibut sandwich, we made it back to our cabin. There was no WiFi or reliable cell service, no TV, no Netflix. We read in bed by daylight. I slept soundly, despite the bright light. No nightmares. No monsters.

The next morning, as I sipped my steaming coffee on our porch, the raven didn’t waste much time to stop by. He paused before coming nearly eye to eye on the roof of the firewood shed in front of me. He looked me up and down and cackled. Not a cawh, not warning me of my intrusion, but rather a vocalization. He just wanted to strike up a conversation with the first guest of the season. He had nothing but time.

On our last night, I lit a fire with wood Jim had cut for us (with help from lots of lighter fluid). Jim ambled over to say goodbye. When I mentioned we had a 2½ hour drive back to Anchorage, he said 3 hours wasn’t a long time for Alaskans. He’d made that drive many times when his kids were little just to take them to McDonald’s. I asked if he ever got burned out, living here. He gave a long pause, turning his chin up, letting the question sink in before constructing an answer. “Burned out? Huh. I don’t know. I guess like when I was pulling green chain in the saw mill. I was pretty tired by the end of the day. But that’s how we sleep so good in Alaska.”

He didn’t get it. In the lower 48, we rush, scramble, and hurry trying to outrun time. At the end, we’re burned out. In Alaska, they don’t know what burned out means. They do understand that time can’t be controlled or beaten. Rather, it is observed and appreciated. I hoped to bring a little of that perspective to clinic on Monday morning.

My recommendation to you if want to sleep better, with fewer nightmares, if you want to reduce your risk for burn out, then go to Alaska (or Montana, or Wyoming, or Idaho, or your backyard). Like Thoreau, we can still learn a lot about life from nature. This is not medical advice, it’s life advice.

Dr. Jeffrey Benabio, director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego.

Dr. Jeffrey Benabio

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].

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